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Traumatic brain injury (TBI) is a leading cause of death and disability among children and young adults.1,2 Unintentional injuries (ie, car accidents and falls) are the leading cause of death for children 1 to 14 years of age.3 Among such injuries, TBI is a leading cause of injury-related morbidity and mortality.4 Furthermore, despite modern automobile design and injury prevention campaigns, important causes of TBI have increased in recent years.5 In addition to unintentional injuries, child abuse remains a significant problem and constitutes the leading cause of serious head injury in infants.6 With nearly half a million children affected each year, TBI is a serious public health problem.7
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Traditionally, TBI severity has been defined using the Glasgow Coma Scale (GCS). The GCS, shown in Table 19-1, was developed in order to standardize the neurological assessment of adult patients with traumatic brain injury.8 It was specifically designed to be easily performed based upon clinical data and to have a low rate of inter-observer variability. Despite its limitations when applied to children,9,10 the GCS is widely used for the initial assessment and for monitoring progress of pediatric TBI. A pediatric version of the GCS also seems to be a reliable tool for predicting the need for acute intervention in preverbal children with TBI.11
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The GCS score is determined by adding the values for eye opening, verbal response, and motor response. Possible values range from 3 to 15. Note that this scale rates the best response only. In patients who are intubated, in whom assessment of best verbal response cannot be performed, notation of this is made in the GCS score by adding a "T" to the end of the score. In patients who are intubated, the best possible score would therefore be 11T. For patients 4 years old or younger, the Pediatric Glasgow Coma Scale is recommended (Table 19-2).
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Certain numerical values of the Glasgow Coma Scale have been used to define the ...